Preference assessment of prenatal diagnosis for Down syndrome: is 35 years a rational cutoff?

Authors

W. A. Grobman,

From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois

S. L. Dooley,

From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois

E. E. Welshman,

From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois

E. Pergament,

From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois

E. A. Calhoun

From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois

Abstract

Objective

To compare the perceptions of miscarriage and birth of a child with Down syndrome among pregnant women and to evaluate the implications of these preferences for the traditional 35-year old maternal age risk boundary.

Methods

An interviewer-administered survey was given to 186 pregnant women receiving antepartum care at a university hospital. Preferences, as reflected by utilities, for birth of a child with Down syndrome and pregnancy miscarriage, stratified by patient characteristics, were assessed.

Results

The utility for the birth of a child with Down syndrome decreased (p < 0.001) as clinical severity increased from mild (0.78) to severe (0.65). Miscarriage of a pregnancy had a mean utility of 0.76 ± 0.31. Women who desired prenatal diagnosis had a utility value for miscarriage (0.79 ± 0.28) that was significantly higher than for the birth of a child with Down syndrome of unknown severity (0.73 ± 0.27). In multivariable logistic regression, desire for prenatal diagnosis was the only factor associated with a preference of miscarriage over birth of an affected child (odds ratio 2.26, 95% confidence interval 1.03, 4.96).